Our EAP Provider Network

Participating with Mazzitti & Sullivan EAP will help you build up or sustain your practice while allowing us to offer a wider variety of agencies to our clients. We are always expanding our national network of EAP providers and welcome qualified counselors to submit their application and W-9 for consideration. Our main requirements for participation in our EAP network include maintaining liability coverage in the amounts of $1 million (individual) and $3 million (aggregate), and either having a state-issued license or working under a licensed counselor.

Become an EAP Provider

Please download and complete the New Provider Application Packet below, along with your W-9 tax ID form, to be considered for our network of EAP counselors. This packet contains all the forms you will need to complete and send back to us. Completed applications with supporting licensure, liability, and tax documentation can be submitted via email to info@mseap.com.A Mazzitti & Sullivan EAP staff member will be in touch with you once we have received your information. Please call 1-800-543-5080 or email us anytime if you have questions about becoming a provider in our EAP network.

For Current Providers

If you are a participating provider with us currently and would like to add a new location or update your existing contact information, please fill out a new Agency Information sheet below. A new W-9 form is also required for updates that affect the payee’s name or address information.For participating providers wishing to add a new counselor to the EAP roster, please complete the Counselor Information document below and email it to info@mseap.com, along with copies of the counselor’s liability coverage and license (or indicate if they are working under a licensed clinician). If the clinician is going to be paid directly, we will also need a completed W-9 form.

How it Works

We strive to keep paperwork to a minimum and do all we can to make the referral process easy for our clients and providers.

We require only two pieces of paperwork: a client Consent to be Treated and our EAP Invoice.

Clients must sign the EAP Information and Consent Form if they are to receive services through the EAP. The form also allows the client to communicate his or her satisfaction with the EAP up to the present point.  (We can also accept other Consent forms, if necessary.)  We must receive a copy of a Consent before we can process payment.

These forms are “fillable” PDFs that can be edited using Adobe Acrobat (a free download) and may be emailed to info@mseap.com within 14 days after the date of service. Please contact the EAP staff (call 1-800-543-5080 or email info@mseap.com) if you have an invoice that is greater than 14 days old to request an exception.
CALL NOW